Necessity of Distinguishing Verrucous Carcinoma From Verrucous Skin Lesion Overlaying Residual Skin Staples in an Area of Sensory Loss: A Case Report

Abstract

Objective: Verrucous skin lesions on the feet in diabetic neuropathy is a condition usually induced by chronic mechanical stimulation of the feet of patients with diabetic neuropathy and usually occurs at weight-bearing sites. We here present a rare case involving a man with verrucous skin lesions on the feet in diabetic neuropathy at an unusual, non-weight-bearing site.

Methods: A 58-year-old man with diabetic neuropathy presented with a verrucous skin lesion overlaying residual skin staples and an amputation stump of the second metatarsal bone on the dorsal foot.

Results: The biopsy findings were inconclusive and suggested the necessity of distinguishing the lesion from verrucous carcinoma. The lesion was resected, and the residual skin staples were simultaneously removed. Investigation of the excisional biopsy confirmed our diagnosis of verrucous skin lesions on the feet in diabetic neuropathy.

Conclusions: Verrucous skin lesions on the feet in diabetic neuropathy is often difficult to distinguish from verrucous carcinoma; in this case, the unusual location of the lesion could be attributed not only to sensory loss but also to the presence of an amputation stump and the persistence of the residual skin staples.

Keywords: VSLDN; diabetic foot; diabetic neuropathy; verrucous carcinoma; verrucous skin lesion.

Figure 1

Clinical and histological findings. (a) A verrucous skin lesion on the dorsum of the left third metatarsal head. (b) Close-up of the lesion. (c) Skin biopsy specimen showing epidermal hyperplasia and elongation of the rete ridges. (d) Individual cell keratinization and mild atypism were observed.

Figure 2

Radiograph and computed tomographic scan. (a) Radiograph showing the presence of skin staples (arrow) at the amputation stump. (b) Computed tomographic scan showing the lesion (arrowhead) overlaying a residual skin staple (arrow); no tumor invasion to the surrounding tissue was evident.

Figure 3

Preoperative and postoperative findings. (a) Resection with a 1-mm horizontal margin was performed. (b) Artificial dermis placed onto the skin defect. (c and d) Resected verrucous nodule with skin staples (arrow).

Figure 4

Histopathology of pseudocarcinomatous hyperplasia. (a) Epidermal hyperplasia and elongation of the rete ridges were observed. (b) No atypia was noted in the elongated rete ridges. (c) Invasion of inflammatory cells was recognized around the skin-stapled site. (d) Two years after the last operation.